Results of surgical treatment in multinodular goiter with an intrathoracic component

Abstract
Purpose  (1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery,
and (3) to analyze the incidence of malignancy and its evolution.

Methods  Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse’s
definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study
was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the χ2 test, Student’s t-test, and a logistical regression analysis.

Results  Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more
than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity
occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which
1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and
the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid
carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a
relapse of the goiter was observed.

Conclusions  Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic
option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled
out, and recurrence can be avoided if a total thyroidectomy is performed.

Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00595-006-3673-zAuthors
Antonio Ríos, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Cirugía Avenida de la Libertad no. 208, Casillas 30007 Murcia SpainJosé M. Rodríguez, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Cirugía Avenida de la Libertad no. 208, Casillas 30007 Murcia SpainPedro J. Galindo, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Cirugía Avenida de la Libertad no. 208, Casillas 30007 Murcia SpainJuan Torres, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Servicio de Cirugía Torácica Murcia SpainManuel Canteras, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Bioestadística Murcia SpainMaría D. Balsalobre, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Cirugía Avenida de la Libertad no. 208, Casillas 30007 Murcia SpainPascual Parrilla, Universidad de Murcia, Hospital Universitario Virgen de la Arrixaca Departamento de Cirugía Avenida de la Libertad no. 208, Casillas 30007 Murcia Spain

Journal Surgery TodayOnline ISSN 1436-2813Print ISSN 0941-1291

Journal Volume Volume 38

Journal Issue Volume 38, Number 6 / June, 2008 (Source: Surgery Today)